The modified Fontan operation for double inlet left ventricle

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Abstract
Twenty-one patients with a double inlet left ventricle underwent amodified Fontan between May 1979 and August 1987. All but the first patientin this series were operated upon after August 1984. Their age at operationranged from 4 to 23 years with a median age of 8 years. Initial palliationwas required in 12 patients and the mean interval to repair was 77.1months, ranging from 38 to 112. Only one of the criteria of Choussat wasexceeded in 12 patients. The pulmonary vascular resistance was always lessthan 4 Um2. A direct atriopulmonary anastomosis was performed in 19patients and an aortic homograft interposition was used in 2. There was onehospital death due to acute cardiac failure and no late deaths. The averageof the mean right and left atrial pressures measured early postoperativelywas 12.9 and 8 mmHg respectively. A prolonged hospitalization with a meanof 23 days, ranging from 9 to 69, was required because of recurrent pleuraland pericardial effusions which usually resolved after the first 6postoperative months. The need for early anticoagulation is recommended toprevent the risk of pulmonary thromboembolism observed in 2 of ourpatients. Cardiac catheterization performed in 19 patients within 1 yearafter surgery showed that the average of the mean right atrial pressure haddecreased to 11.3 mmHg without a gradient across the anastomosis in anycase. Two patients required reoperation: one for enlargement of arestrictive ventricular septal defect and the other for closure of arecurrent dehiscence of the patch used for closure of the right a-v valve.Three patients developed a significant subaortic obstruction and have beenscheduled for reoperation. Ventricular function was assessed at a meaninterval of 11.9 months (17 patients) and 25.5 months (13 patients) fromsurgery. Gated equilibrium radionuclide ventriculography showed that theejection fraction was normal (greater than or equal to 50%) and it hadincreased with time in 10. Yet, the response to exercise was normal in only5 of the 13 patients re-evaluated. Treadmill exercise testing showed anincrease in exercise tolerance from a mean of 7.4 min to a mean of 8.7min.(ABSTRACT TRUNCATED AT 400 WORDS)